Affiliation:
1. University of Wisconsin–Madison School of Pharmacy, Madison, WI, and William S. Middleton Memorial Veterans Hospital, Madison, WI
2. William S. Middleton Memorial Veterans Hospital, Madison, WI
Abstract
Abstract
Purpose
To analyze the impact of a 12-week extended International Normalized Ratio (INR) follow-up interval on healthcare use.
Methods
A prospective cohort study of the use of an extended INR follow-up interval of up to 12 weeks was conducted over 2 years in a pharmacist-managed anticoagulation clinic. A detailed protocol was used to extend the INR follow-up interval to 5–6 weeks and then 7–8 weeks and 11–12 weeks. The number of planned and unplanned anticoagulation encounters, procedures requiring warfarin interruption, telephone triage phone calls, emergency department visits, and hospitalizations were collected. A post hoc subanalysis was also completed on participants who were scheduled for 4 consecutive 12-week intervals.
Results
Compared to baseline, at 12 months there was a mean decrease in planned anticoagulation encounters of 2.24 visits (p < 0.001) among 44 participants. From 12 to 24 months compared to baseline, there was a mean decrease in planned anticoagulation encounters of 3.13 visits (p < 0.001) and an increase of 0.54 unplanned anticoagulation encounters (p = 0.04) among 39 participants. The remainder of healthcare use variables were not statistically significantly different from baseline at any time point. Of the 15 participants scheduled for 4 consecutive 12-week intervals, there was a decrease from baseline of approximately 5 visits over the course of a year (p < 0.001).
Conclusion
An extended INR follow-up interval appears to decrease anticoagulation healthcare use without an increase in acute healthcare use. While this intervention could be cost-effective, institutions need to consider safety, efficacy, and feasibility prior to implementation.
Funder
Clinical and Translational Science Award
National Center for Advancing Translational Sciences
Publisher
Oxford University Press (OUP)
Subject
Health Policy,Pharmacology
Cited by
1 articles.
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